Timing of Elective SurgeryElective aortic surgery is offered when the risk of rupture or dissection is greater than the risk of surgery. Declining surgical risk and the accompanying improved outcomes allow surgery to be performed earlier in the disease today than in the past, intervening before life-threatening rupture or dissection occurs. In determining the timing of surgery, the overall condition of the individual and their aortic tissue is evaluated, considering several factors including:

Medical treatment of various aortic pathologies entails the following:

Strict control of the blood pressure and heart rate

Smoking cessation

Blood cholesterol and sugar control

Avoiding any risky activities that increases the risk of aortic rupture: lifting heavy weights, any activities that put the patient at risk for fall (deceleration injury) such as contact sports, bike and horse back riding, etc.

Reasons for Early InterventionThe ascending aortic aneurysm is replacement to prevent acute type A aortic dissection and rupture. The rule of thumb for replacement in low-risk population (no history of connective tissue disorder such as Marfan’s patients, no family history of ruptured/dissected aorta or peripheral vessels, and certain medical conditions increasing the risk of rupture) has been any ascending aorta greater than 5.5 cm or twice the indexed aortic size (to factor in patient’s height).

Recent studies, performed by Gorman Cardiovascular Research Group at University of Pennsylvania found that 62% of adult patients presenting with life-threatening type A aortic dissection had a maximum aortic diameter less than 5.5cm; in 42% of patients, largest diameter of the ascending aorta was less than 5cm, and 20% had maximal ascending aortic diameters less than 4.5cm. Based on this study, the group recommended that preventive replacement of the ascending aorta should be considered at sizes 4.5-5.5cm, especially in centers specializing in aortic care.